Department of Research, UTHealth Houston Cizik School of Nursing, Houston, Texas,USA.
Department of Psychology, College of Health Science, University of Rhode Island, Kingston, Rhode Island, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Oct 1;79(10). doi: 10.1093/geronb/gbae138.
The purpose of this paper is to evaluate the mechanistic process by which family caregivers' situational stress appraisals of behavioral symptoms of dementia (BSD) increase the likelihood of a caregiver engaging in abusive and neglectful behaviors toward their care recipient with dementia. We test the hypotheses that (1) the effect of daily BSD stress appraisals on elder abuse and neglect (EAN) is mediated by the caregivers' emotion dysregulation (2) and the mediation path is moderated by self-compassion.
This study employed a multitime series design in which participants (N = 453) completed traditional longitudinal surveys at enrollment followed by 21 sequential days of diary surveys (n = 9,513). The hypothesized moderated mediation path was evaluated through a multilevel structural equation model.
Hypotheses were supported. At the within-person level, daily BSD stress appraisal has a significant direct effect on daily EAN. At the between-person level, the path was no longer significant implying a full mediation of emotion dysregulation. The main effect of self-compassion and the interaction term (emotion dysregulation × self-compassion) were also statistically significant indicating the path between emotion dysregulation and EAN is moderated by self-compassion.
This study significantly advances the field by empirically showing a mechanistic pathway for a theoretical explanation of EAN. These findings represent a breakthrough for the field and identify modifiable intervention targets for future behavioral interventions to prevent EAN. Emotion (dys)regulation and self-compassion are modifiable traits and skills that can be learned, with robust evidence bases of efficacious interventions that can be adapted for context to dementia family caregiving.
本文旨在评估家庭照顾者对痴呆症行为症状（BSD）的情境压力评估增加其对痴呆症患者实施虐待和忽视行为可能性的机制过程。我们检验了以下假设：（1）每日 BSD 压力评估对虐待和忽视老年人（EAN）的影响是由照顾者的情绪失调介导的；（2）该中介路径受到自我同情的调节。
本研究采用多时间序列设计，参与者（N=453）在入组时完成传统的纵向调查，随后进行 21 天的日记调查（n=9513）。通过多层次结构方程模型评估假设的调节中介路径。
假设得到支持。在个体内水平上，每日 BSD 压力评估对每日 EAN 有显著的直接影响。在个体间水平上，该路径不再显著，意味着情绪失调的完全中介。自我同情的主要效应和交互项（情绪失调×自我同情）也具有统计学意义，表明情绪失调和 EAN 之间的路径受到自我同情的调节。
本研究通过实证研究为 EAN 的理论解释提供了一个机制途径，从而在该领域取得了重大进展。这些发现代表了该领域的突破，并确定了可干预的干预目标，以用于未来预防 EAN 的行为干预。情绪（失调）调节和自我同情是可改变的特征和技能，可以通过具有强大干预效果证据基础的干预措施来学习，这些干预措施可以针对痴呆症家庭护理的背景进行调整。
